Half of Spain’s non-smokers breathe terrace smoke as 1.6 million die each year

No non-smoker wants to sit down outside a café and be smothered by a cloud or two of second-hand smoke from the next table along. It can ruin a morning break or an afternoon drink, and unfortunately, too much of it can also cause irreversible damage. The smoke drifting over from the next table is now part of a worldwide count of 1.66 million deaths a year, and in Spain it is the terrace, not the bar, where most non-smokers say they breathe it.

Heart disease, not lung cancer, does most of the damage

The figures come from a Global Burden of Disease study published in The Lancet Public Health on Monday September 7, led by researchers at the University of Washington and covering 204 countries and territories between 1990 and 2023. It found that 2.71 billion people who do not smoke were still breathing tobacco smoke in 2023, close to one in three of everyone alive.

Lung cancer is the illness most people attach to tobacco, but it is not what kills most passive smokers. Heart disease accounted for around 537,000 of the deaths, ahead of chronic lung disease at about 354,000 and stroke at roughly 278,000. Lung cancer came fifth, at about 161,000. Between them, those illnesses cost 44.8 million years of healthy life.

The 767 million children who can’t walk away

Children aged 14 and under account for 767 million of those exposed, and for more than 12 per cent of the total harm. Chest infections are what the smoke does to them most often. An adult can move tables. A child breathing smoke in the back of a car or in a living room cannot simply dissapear, which is why the researchers pointed to homes and private vehicles as the places where voluntary rules would do most good.

Women make up more than half of everyone exposed. In much of Asia and the Pacific, where far fewer women smoke than men, they are still the ones breathing it in.

Why Spain’s problem moved outdoors

Spain cleared the smoke out of its bars in January 2011, when a reform of the tobacco law banned smoking in every enclosed public space, cafés and restaurants included, with no exceptions for smaller premises. What it didn’t do was follow smokers out to the terrace, and that is where the exposure now sits. Research by SEPAR, the Spanish Society of Pulmonology and Thoracic Surgery, published in September 2024, found that roughly half of non-smokers are exposed to tobacco smoke on terraces and in outdoor leisure areas, easily the biggest single source in the country. 

Taken together, 24 per cent of people in Spain are breathing someone else’s smoke somewhere. Across 13 years, the same research found exposure had crept up at home, at work and in educational centres rather than falling away.

Nearly 5,000 deaths in Spain in six years

Spanish researchers have already put a domestic figure on the cost. A study in the Revista Española de Cardiología linked second-hand smoke to 4,970 deaths from heart disease and lung cancer between 2016 and 2021, including 747 in 2020 alone. The heaviest burden fell on people who had never smoked at all, and particularly on women. Andalucía recorded the highest death rates of any region.

The pattern is familiar in the UK, where indoor smoking was banned in 2007. Action on Smoking and Health estimates that exposure at home still causes around 2,700 deaths a year among people aged 20 to 63, and a further 8,000 among people aged 65 and above. About two million British children are regularly exposed indoors.

The terrace ban is still only a bill 

The Spanish government approved a tobacco bill on Tuesday July 21 that would extend smoke-free rules to terraces, beaches, swimming pools, sports grounds and national parks, and create 15-metre buffer zones around schools and hospitals. It still has to clear parliament, and no start date has been set.

Alberto Ruano Raviña, professor of preventive medicine and public health at the University of Santiago de Compostela and a co-author of the Spanish mortality research, told Science Media Centre España that the reform was welcome but limited. “Whilst the law is a positive step, it will not have a significant impact on tobacco-related mortality in Spain,” he said.

The global study lands in a similar place. Exposure has fallen as a share of the world’s population since 1990, but the number of people breathing other people’s smoke has barely shifted, because there are more people to breathe it. Around a third of the world’s population is currently covered by the strongest smoke-free laws. Everyone else is still waiting for a rule that reaches the table next to them.